1.Sisters Act – FGM, Designer Vaginas and Gender Based Violence

TW (Trigger Warning): This article is about female genital mutilation (FGM – also known as female circumcision, Sunna or Bondo), its forms and causes. There is explicit mention of the female genitalia and its biological functions as well as other forms of sexual and gender based violence. Non-graphic educational images of the female sexual organs are included. If you have been affected by anything discussed here please contact FORWARD for advice, support and help.


Over 200million women and girls alive today have undergone female genital mutilation (FGM). That’s equivalent to 2/3rd of the American population! But what is FGM, why does it happen and how is it a form of gender based violence?


In 1997, the World Health Organisation classified female genital mutilation as the following:

  1. All procedures that involve partial or total removal of the external female genitalia for non-medical reasons
  2. All other injury to the female genital organs for non-medical reasons

natural-vThe female genitalia in its natural state is made up of the vulva, the name for the entire pubic area which is often (mistakenly) called the vagina. The clitoris is the female sexual organ and it is covered by a hood called the prepuce. Below the clitoris is the urethra where urine is expelled from. Further down lies the vagina, a muscular tube that leads to the womb. As a muscle, the vagina is designed to expand and contract e.g. during penetrative sex, menstruation, vaginal discharge and childbirth. The vagina is located before the anus. The final parts of the female genitalia are the labia. The labia, or lips, surround the clitoris and vagina. The labia majora (big lips) are on the outside and the labia minora (little lips) lie inside. Containing thousands of nerve endings, when stimulated the labia minora, like the clitoris, fills with blood. It is important to remember that, in terms of size, shape, colour etc, every woman looks different and her genitals  are unique to her person.

Female genital mutilation (FGM) involves any injury to these parts for non-medical reasons. While FGM might take a variety of forms, the WHO have identified four main types.

Type 1:type-1-v

Type 1 is known as a ‘Clitoridectomy’. This involves the total or partial removal of the clitoris from the rest of the female genitalia. In rare cases it also includes the removal of the prepuce, the fold of skin surrounding the clitoris.

Q: What is the clitoris, and why is this problematic?

The clitoris is the main female sexual organ. Existing purely for sexual pleasure the clitoris has over 8000 nerve endings, more than double the amount of nerves found in the male penis, or anywhere else in the human body. The clitoris is around 2-3cm in length, with the majority situated within the female body leaving only the head exposed. As an organ the clitoris fills with blood upon stimulation. This means that if cut, blood loss can be fatal.

Considering FGM is often practiced by women who have no medical training, cutting is done without anaesthetics and often by using razor blades or other crude materials. Girls are often cut together during ‘coming of age ceremonies’ or at birth. This means the same blade is used to cut multiple girls, drastically increasing the risk of infection and the transmission of diseases such as HIV/AIDS. A highly traumatic procedure, immediate health risks can include infection, shock, injury to the surrounding genital tissue, excessive bleeding (haemorrhaging), urinary problems and infections, scarring and death.type-2-v

Type 2:

Type 2 is known as ‘Excision’. Excision involves the partial or total removal of the clitoris, the labia minora and/or the labia majora.

Type 2 presents the same immediate health risks as Type 1.

Type 3:type-3-v

Type 3 is called ‘Infibulation’ and is the most invasive form of FGM. Infibulation requires the creation of a covering seal by narrowing the vaginal opening. The seal is formed by cutting and repositioning either the labia minora, majora or both, and then stitching them together. Infibulation might also include the removal of the clitoris.

Considering the vagina is a muscle that is meant to expand, infibulation has severe adverse effects. Along with the previously mentioned health risks, infibulation may also include vaginal problems such as bacterial infections, menstrual problems including painful and often heavy periods as it becomes difficult to pass blood and other fluids, complications in child birth (e.g. the need to have a C-section, difficult delivery, excessive bleeding, the development of fistula), pelvic infections, discomfort and pain during intercourse, and sexual dissatisfaction. Women and girls who have been infibulated may need to be cut and re-stitched multiple times throughout their life (e.g. during childbirth, penetrative sex). This is extremely traumatic and may also result in the build-up of scar tissue and keloids which further reduce the elasticity and expansion capacity of the vagina.

Type 4:

Type 4 refers to any other injury to the female genital organs. This can include pricking or piercing any part of the genitalia, incising (cutting), scraping any part of the genitals, using corrosive substances, pulling, stretching the labia, cauterising any part of the genitalia and any other form of injury imagined or practiced for non-medical reasons.

Although the WHO present FGM as four clear types, in practice women and girls may have a combination of any of the four forms of FGM. There are a variety of reasons behind this ‘imprecision’ including the fact that FGM is often done by ‘traditional cutters’, women with no medical background or training who use crude materials, resulting in imprecise alterations. Many cutters are unable to determine how much or how little one wants to cut – and once a ‘mistake’ is made it is permanent unless one undergoes reconstructive surgery. As some girls are cut as young as one week old, age and size can also be a factor. The physical trauma also means that many girls and women struggle during the procedure and are often held down, this will also affect how much is removed or damaged.

Why not medicalise FGM?


The medicalisation of FGM is a controversial topic. Those who argue for it believe that with anaesthesia and the correct surgical tools some of the issues surrounding FGM (extreme trauma, extensive health problems etc) would no longer exist. This isn’t true. Removing the initial pain of the procedure does not remove or prevent the immediate and long term health risks caused by FGM.

But can a doctor do the procedure?


Before doctors can practice medicine they must take something called the Hippocratic Oath. This includes swearing an oath to ‘do no harm’. FGM requires the removal of healthy tissue for non-medical reasons which can result in various and often severe physical, mental and emotional health problems including death. The fight to end FGM is about safeguarding the sexual, reproductive and health rights of women and girls, something FGM explicitly violates, therefore medicalisation is not an appropriate response to this practice.

What about Designer Vaginas?

‘Designer Vaginas’ are another controversial issue. An emerging form of elective plastic surgery, this procedure is predominantly practiced in the West (North America, Europe, and Australasia). This is when women chose to alter their vaginas (e.g. removing their clitoral hood, enlarging or reducing the size of their clitoris or of their labia, tightening their vaginal opening etc) for cosmetic reasons. Proponents of the procedure argue it is done with consent whereas FGM isn’t, however the desire to alter one’s genitalia is still rooted in the same misogynistic cultural views that fuel FGM.

Legally consent is defined as:

An act of reason and deliberation made by a person who possess and exercises sufficient mental capacity to make an intelligent decision. Consent assumes the power to act and a reflective, determined, unencumbered (unconstrained) exertion (use) of those powers which are unaffected by fraud, duress (pressure) or a mistake.

A variety of reasons including increased access to pornography,  fashion indsutry and the ease with which we can now ‘modify’ ourselves for improved self-esteem or perceived sexual pleasure, have led to  a rise in ‘Designer Vagina’ cosmetic surgery. On one hand skewed representations of the female genitalia fuel an idea of what is ‘attractive’, ‘sexually desirable’ or even ‘normal’, and are, like FGM, rooted in misogynistic ideas about women’s bodies and their sexuality. There is also a racial aspect to the Designer Vaginas vs. FGM debate which subtly implies that such procedures are only violations or ‘barbaric’ when they occur in black/African/Islamic/impoverished settings – which just isn’t the case. In many ways Designer Vaginas are simply another way to ‘medicalise’ what, in other parts of the world, would be regarded as a gross form of gender based violence. Moreover, the health risks associated with FGM are still prevalent with Designer Vaginas – surely this is the same practice under a different name?

Why is FGM a form of gender based violence?

FGM is regarded as a form of gender based violence and a violation of women and girl’s human rights because it violates a person’s right to health, security, physical integrity, freedom from torture, freedom from cruel, inhuman or degrading treatment and, when the procedure results in death, it denies the person’s right to life. The vast majority of procedures are carried out on children (those under the age of 18) therefore FGM in this scenario directly violates the rights of the child. However even when FGM is undertaken on adults, it is often a choice that is taken without true consent, as defined by the law. The reasons behind FGM and the results of having FGM are rooted/result in a clear inequality between the sexes, and thus FGM is an extreme form of sexual and gender based discrimination.

Who Practices FGM?

fgm-prevalence-map-africaFGM has existed for centuries in all parts of the world. In Europe and the United States Clitoridectomies were performed from as early as the 19thC up until 1960s as a ‘cure’ for hysteria, lesbianism, excessive masturbation, nymphomania (hypersexuality) and idiocy. However, the majority of FGM practicing communities are found on the African continent. Over 36 African countries have FGM practicing communities, while the procedure is also prevalent in around 11 South/South East Asian and 12 Middle Eastern countries. Indigenous communities in Latin America have also been found to practice FGM, while the prevalence rates in Europe, Australasia and North America are predominantly linked to immigrant communities who come from FGM practicing countries and cultures.

 Why do they do it?

Although no-one is sure how or why FGM began, there are a number of reasons why it is still practiced today. FGM is a cultural practice. It is not a religious requirement. In many FGM practicing communities FGM is seen as a rite of passage that transforms girls into marriageable women. FGM is practiced in patriarchal societies where women’s sexuality is often highly policed and regulated, thus FGM becomes a way of ‘ensuring’ women’s chastity, ‘preventing’ promiscuity and in some cases ‘protecting’ women from sexual violence (e.g. rape. This is a perverse, misguided view as rape has nothing to do with sexual ‘availability’ and everything to with power and the abuse of that power. FGM for these reasons will still leave girls and women vulnerable to sexual violence, including both anal and/or vaginal rape).

In many parts of the world, women do not have the same social, economic or political rights as men. Moreover, their security and wellbeing are tied to their male relatives. That means marriage is a form of survival. If a woman doesn’t marry well, or marry at all, she may find herself destitute and vulnerable to further sexual or labour exploitation. In some communities, girls and women who have not been cut are regarded as ‘loose’ women, whores and therefore sexually available. FGM then becomes a way of ensuring a women’s economic and social safety, and also a way of giving status and even power to those who would otherwise remain socially, economically and politically disempowered.

 Although FGM is very clearly a form of abuse, many practicing communities don’t regard it as such. In most cases the procedure is done out of a sense of love and parental or familial duty to safeguard and protect the future and safety of one’s female relatives.

FGM, Culture and the Future

At the heart of it, FGM is a practice that is done to women, by womlearning-to-be-freeen, for men. It is not necessary but rather extremely harmful. Although some people see it as part of their cultural heritage and identity, culture is dynamic. That means it can and does change. So why not change FGM? Why not change the cultures which devalue women and seek to police their sexuality? Why not change the cultures that prevent women from being independent and economically free so that they can have a secure future irrespective of their marriage status? Why not change the cultures which hold female chastity to a higher standard than male chastity? If FGM is the product of a patriarchal culture, then let’s change that culture and in the process safeguard women and girls’ sexual and reproductive health rights.

Join the conversation and leave your thoughts in the comments below. #SistersAct


If you have been affected by any of the issues mentioned please contact one of our partners by clicking on their links:

FORWARD (UK, Europe and Africa incl. Ethiopia, Sierra Leone, Tanzania)

YWLI (Kenya)

AMwA (Uganda)

SSAP and the Edna Adan Hospital Foundation (Somaliland)

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